Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6807 | MA |
N | 103TC0700X | Clinical Psychologist | 6807 | MA |
N | 102L00000X | Psychologist | 6807 | MA |
N | 103T00000X | Psychologist | 6807 | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 6807 | MA |
Y | 103G00000X | Clinical Psychologist | 6807 | MA |
Y | 103TC0700X | Clinical Psychologist | 6807 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 6807 | MA |
N | 103TP2701X | Group Psychotherapist | 6807 | MA |
NPI | 1013137447 |
---|---|
Provider Name | Paul Davidson |
First Address | Canton, MA 02021-1940 |
Second Address | Canton, MA 02021-1940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 28/08/2020 |